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General NPI Number Information
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NPI Number | 1013166727
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Entity Type | Individual
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Provider Name | JENNIFER L GERBASI DDS
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Gender | Female
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Dates
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Enumeration Date | 09/17/2008
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Last Update Date | 04/05/2022
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Provider Practice Location Address
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Address Line | 5600 MAHONING AVE
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City | AUSTINTOWN
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State | OH
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Zip | 44515-2317
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Country | US
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Telephone | 330-318-3150
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Fax |
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Provider Business Mailing Address
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Address Line | 5600 MAHONING AVE
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City | AUSTINTOWN
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State | OH
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Zip | 44515-2317
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Country | US
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Telephone | 330-318-3150
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Fax | 330-270-2863
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 30022886
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 30-022886
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License Number State | OH
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